Opioid Addiction

Excerpt

Opioid use disorder and opioid addiction remain at epidemic levels in the US and worldwide. Three million US citizens and 16 million individuals worldwide have had or currently suffer from opioid use disorder (OUD). More than 500,000 in the United States are dependent on heroin. The diagnosis of OUD is made by meeting two or more of the eleven criteria in a year time period.

The key elements are as follows:

1. Increasing dose/tolerance

2. Wish to cut down on use

3. Excessive time spent to obtain or use the medication

4. Strong desire to use

5. Use interferes with obligations

6. Continued use despite life disruption

7. Use of opioids in physically hazardous situations

8. Reduction or elimination of important activities due to use

9. Continued use despite physical or psychological problems

10. Need for increased doses of the drug

11. Withdrawal when the dose is decreased

The increase in OUD can be partially attributed to overprescribing of opioid medications. Healthcare providers in the 1990s increased opioid prescribing in response to the "pain as fifth vital sign" campaign, downplay of the abuse potential of opioids, and aggressive marketing of drugs such as Oxycontin and Opana. Risk factors for misuse of these medications are initiation at a young age, previous history of illicit drug or alcohol abuse, family history of illicit drug or alcohol abuse, sexual abuse in females, adverse childhood experiences, and psychological comorbidities (depression, bipolar disorder, and attention deficit hyperactivity disorder)